HLT 362 Week 5 Article Analysis And Evaluation Of Research Ethics

HLT 362 Week 5 Article Analysis and Evaluation of Research Ethics

Article Analysis and Evaluation of Research Ethics

Article Citation and Permalink

(APA format)

Article 1

Yakkanti, R. R., Miller, A. J., Smith, L. S., Feher, A. W., Mont, M. A., & Malkani, A. L. (2019). Impact of early mobilization on length of stay after primary total knee arthroplasty. Annals of Translational Medicine, 7(4), 69. https://doi.org/10.21037/atm.2019.02.02

Point

Description

Broad Topic Area/Title

The impact of early mobilization on hospital length of stay (LOS) and discharge destination after primary total knee arthroplasty (TKA)

Problem Statement

(What is the problem research is addressing?)

The prolonged hospital stay after any kind of surgery is associated with higher complications as well as a costly burden on individuals and the healthcare system. The study addresses an intervention (early mobilization) that aims to minimize LOS and optimize discharge to home for patients who have had TKA.

Purpose Statement

(What is the purpose of the study?)

To determine if mobilization on the day of surgery (postoperative day 0 or POD 0) has an effect on the hospital LOS and discharge destination.

Research Questions

(What questions does the research seek to answer?)

Does mobilization on the POD 0 decrease hospital LOS compared to mobilization on a postoperative day 1 (POD 1)

Is there a difference in discharge destination among patients undergoing primary TKA who are mobilized on POD 0 versus those mobilized on POD 1?

Define Hypothesis

(Or state the correct hypothesis based upon variables used)

Early mobilization leads to reduced hospital LOS and plays a role in discharge disposition more frequently to home versus a subacute facility.

Identify Dependent and Independent Variables and the Type of Data for the Variables

Independent variables: Patient mobilization on the day of surgery (POD 0) versus the day following surgery (POD 1)

Dependent variables: Hospital LOS and discharge destination (home versus sub-acute facility or rehabilitation center)

Population of Interest for Study

Post-operative patients who have undergone primary TKA at a single institution by the same surgeon with the same implant design from July 1, 2015, to June 30, 2016

Sample

406 patients

185 mobilized on POD 0

221 mobilized on POD 1

Sampling Method

Convenience sampling

Patients were mobilized on POD 0 or POD 1 based on the timing of the patient’s arrival on the orthopedic floor, and the availability of the physical therapy (PT) staff.

Patients who arrived at the orthopedic floor before 5 P.M were mobilized on the same day, while those who came after 5 P.M were mobilized the following day due to the unavailability of the PT staff

Identify Data Collection

Identify how data were collected

Review of patient charts

Summarize Data Collection Approach

Patent charts were examined for sociodemographic data, medical a surgical data, diagnosis (indication for surgery), side of procedure, ASA score, essential perioperative, laboratory results, PT metrics.

Discharge data was also collected (LOS, discharge disposition)

Discuss Data Analysis

Include what types of statistical tests were used for the variables.

The two groups were compared for LOS using univariate analysis.

A student’s t-test was performed comparing LOS between POD 0 and POD 1 groups.

A chi-squared test was performed to compare the destination at discharge.

Age, gender, ASA score, and BMI-matched cases between the two groups were analyzed for the final statistical analysis.

The level of significance was set at a P value of <0.05

Summarize Results of the Study

406 TKA’s were reviewed, 185 patients in the POD 0 and 221 in the POD 1 group

After matching the cases based on gender, age, ASA score, and BMI, a total of 143 cases in each group (286 in total) was yielded

· The average age for all patients is 66.7 (range, 45-86)

· The average LOS in POD 0 was 2.44, while in POD 1 was 2.80 (p, 0.002)

· 70.63% (n=101) were discharged home in POD 0 versus 58.74% (n=84) in POD 1 (p, 0.035)

Summary of Assumptions and Limitations

Identify the assumptions and limitations from the article.

Report other potential assumptions and limitations of your review not listed by the author.

The use of a retrospective design is an inherent weakness of the study

Several factors were uncontrolled that could also play a role in patient mobilization, such as length of time spent in the PACU, availability of PT resources, level of postoperative pain control, duration of the motor nerve block, which limits the patient’s ability to mobilize the quadriceps muscle, and the inherent motivation level of the

patient

Potential limitations not listed by the author

Inadequate PT personnel or a lack of an efficient shift work arrangement to assure PT staff presence on the orthopedic floor beyond 5 p.m. Patients were not mobilized early on POD 0 due to the PT staff’s unavailability after 5 p.m.

Ethical Considerations

Evaluate the article and identify potential ethical considerations that may have occurred when sampling, collecting data, analyzing data, or publishing results. Summarize your findings below in 250-500 words. Provide rationale and support for your evaluation.

The purpose of this study is to determine whether early mobilization affects hospital LOS and the discharge destination of TKA patients. Yakkanti et al. (2019) achieve the study’s purpose by concluding unequivocally that early mobilization on the day of surgery (TKA) minimizes hospital LOS and optimizes release to home rather than sub-acute institutions. Like any other ethically authorized study, the author was obligated to preserve the rights of the study participants and follow the guidelines of the research ethics committee.

As such, the study proposal was reviewed by the University of Louisville Institutional Review Board (IRB), which authorized it and issued a green light to the researchers. The IRB committee is dedicated to protecting human subjects and serving as an oversight body to guarantee that human subjects’ rights are not abused as a result of their involvement in research (Walden University, 2020).

Furthermore, all patient data were de-identified in accordance with HIPAA de-identification guidelines, a body that safeguards the privacy of patients’ health information. De-identification refers to the elimination of identifying data from a dataset (Chevrier et al., 2019). To ensure the anonymity of study participants, patient identifiers such as name, phone number, date of birth, and social security number must be removed.

The University of Louisville Institutional Review Board not only approved the research but also granted a complete waiver of consent. As a result, no formal informed consent was acquired or necessary to perform the study. There is no requirement for consent in retrospective research if the patients have been anonymized; nonetheless, permission from the IRB is required.